1. AUTISM

2. Overview What is Autism? Is there more than one type of Autism?
What causes Autism?
How is Autism diagnosed?
What are the characteristics of Autism?
What are the most effective approaches to treating Autism? Is there a cure?

3. WHAT IS AUTISM? Very complex, often baffling developmental disability
First described by Leo Kanner in 1943 as early infantile autism
“Auto” – children are “locked within themselves.”
For next 30 years, considered to be an emotional disturbance

4. WHAT IS AUTISM? 3 categories for autism in IDEA?
Today, autism is a severe form of a broader group of disorders
These are referred to as pervasive developmental disorders (later)
Typically appears during the first 3 years of life

5. WHAT IS AUTISM?
Very likely neurological in origin – not emotional, not the refrigerator mom
Prevalence is 2-6/1000 individuals (1/2 to 1 ½ million affected)
4 times more prevalent in boys
No known racial, ethnic, or social boundaries
No relation to family income, lifestyle

6. WHAT IS AUTISM?
Autism impacts normal development of the brain in areas of social interaction and communication skills.
Difficult to communicate with others and relate to the outside world.
Occasionally, aggressive and/or self-injurious behavior may be present.

7. WHAT IS AUTISM?
May exhibit repeated body movements (hand flapping, rocking).
Unusual responses to people
Attachment to objects
Resistance to change in routine
Sensory sensitivities

8. WHAT ARE THE TYPES?
Actually, the “umbrella” heading is Pervasive Developmental Disorder (PDD).
Autism is one of the 5 PDDs.
All have commonalities in communication and social deficits
Differ in terms of severity

9. 1. Autistic Disorder
Impairments in social interaction, communication, and imaginative play.
Apparent before age 3.
Also includes stereotyped behaviors, interests, and activities

10. 2. Asperger’s Disorder
Impairments in social interactions, and presence of restricted interests and activities
No clinically significant general delay in language
Average to above average intelligence

11. 3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)
Often referred to as atypical autism
Used when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors

12. 4. Rett’s Disorder
Progressive disorder which, to date, has only occurred in girls.
Period of normal development and then the loss of previously acquired skills
Also loss of purposeful use of hands, which is replaced by repetitive hand movements
Beginning at age of 1-4 years

13. 5. Childhood Disintegrative Disorder
Normal development for at least the first 2 years
Then significant loss of previously acquired skills

14. Conclusions on Types Autism is a spectrum disorder
This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severe
Autistic individuals can be very different from each other
“Autism” is still commonly used to refer to any of the 5 PDDs

15. What causes (and doesn’t cause) autism?
Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry, and genetic factors
Bettleheim’s theory of psychogenesis?

16. How is Autism Diagnosed?
No definitive medical test
Team uses interviews, observation, and specific checklists developed for this purpose.
Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc.
Must rule out MR, hearing impairment, behavior disorders, or eccentric habits

17. CHARACTERISTICS 1. Communication/Language 2. Social Interaction
3. Behaviors
4. Sensory and movement disorders
5. Resistance to change (predictability)
6. Intellectual functioning

18. 1. Communication/language
Broad range of abilities, from no verbal communication to quite complex skills
Two common impairments:
A. Delayed language
B. Echolalia

19. A. Delayed language
50% of autistic individuals will eventually have useful speech (?)
Pronoun reversal: “You want white icing on chocolate cake.”
Difficulty in conversing easily with others
Difficulty in shifting topics
Look away; poor eye contact
Facilitated communication??????

20. Elements of Facilitated Communication
1. Physical Support
2. Initial training/introduction
3. Maintaining focus
4. Avoiding competence testing
5. Generalization
6. Fading

21. B. Echolalia Common in very young children (Age 3)
Immediate or delayed (even years)
Is there communicative intent with echolalia?

22. 2. Social Interaction
One of hallmarks of autism is lack of social interaction
1. Impaired use of nonverbal behavior
2. Lack of peer relationships
3. Failure to spontaneously share enjoyment, interests, etc. with others
4. Lack of reciprocity
Theory of mind?

23. 3. Behaviors
Repetitive behaviors, including obsessions, tics, and perseveration
Impeding behaviors (impede their learning or the learning of others)
Will need positive behavior supports
A. Self-injurious behavior
B. Aggression

24. 4. Sensory and movement disorders
Very common
Over- or under-sensitive to sensory stimuli
Abnormal posture and movements of the face, head, trunk, and limbs
Abnormal eye movements
Repeated gestures and mannerisms
Movement disorders can be detected very early – perhaps at birth

25. 5. Predictability Change in routine is very stressful
May insist on particular furniture arrangement, food at meals, TV shows
Symmetry is often important
Interventions need to focus on preparing students for change if possible

26. 6. Intellectual functioning
Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardation
In general, majority of individuals with autism are also identified as having mental retardation – 75% below 70
Verbal and reasoning skills are difficult
Savant syndrome

27. Interventions 1. Individualization and early intervention are the keys
2. Include life skills, functional academics, and vocational preparation
3. Positive behavior support
4. Social stories (music therapy?)
5. Lovaas model